Dobrovolskaya S V, Saidova M A, Safiullina A A, Uskach T M, Tereshchenko S N
National Medical Research Center of Cardiology, Moscow, Russia.
Kardiologiia. 2021 Dec 31;61(12):31-40. doi: 10.18087/cardio.2021.12.n1849.
Aim To analyze echocardiographic parameters that reflect left ventricular (LV) myocardial contractility, using a novel method for evaluation of myocardial performance in patients with chronic heart failure (CHF) and atrial fibrillation (AF) during heart contractility modulation (HCM).Material and methods Standard echocardiographic parameters and indexes of myocardial strain and work were analyzed for 66 patients (52 men and 14 women; median age, 60 [54; 66] years). 36 patients had paroxysmal AF and 30 patients had permanent AF. All patients had CHF with a duration of 17 [4; 60] months; duration of AF was 12 [6; 36] months. At baseline, the left ventricular ejection fraction (LV EF) was 33 [27; 37] %.Results After one year of HCM, LV EF significantly increased from 33 [27; 37] to 38 [33; 44] % (р=0.001). Also, there were improvements in the myocardial global longitudinal strain (from -6.00 [ - 8; - 4] to -8 [ - 10; - 6] %; р=0.001) and parameters of myocardial work, including the global work efficiency (from 74 [65; 79] to 80 [73; 87] mm Hg%; р=0.001), global constructive work (from 699 [516; 940] to 882 [714; 1242] mm Hg%; р=0.001), and global myocardial work index (from 460 [339; 723] to 668 [497; 943] mm Hg%; р=0.001). A segmentary analysis of LV work parameters showed positive changes in the myocardial constructive work in the area of the interventricular septal apical segment (at baseline, 844 [614; 1224]; after HCM, 1027 [800; 1520] mm Hg%; р=0.05) and the medium segment of the LV anteroseptal wall (at baseline, 593 [312; 1000]; after HCM, 877 [494; 1145] mm Hg%; р=0.05).Conclusion This method for analysis of the myocardial work provides a more detailed examination of LV structural and functional remodeling and mechanisms for its effects on the LV contractile function in patients with CHF. This method is promising and merits further study in various clinical situations.
目的 采用一种新方法评估慢性心力衰竭（CHF）合并心房颤动（AF）患者在心脏收缩力调制（HCM）期间的心肌性能，分析反映左心室（LV）心肌收缩力的超声心动图参数。
材料与方法 对66例患者（52例男性和14例女性；中位年龄60[54；66]岁）的标准超声心动图参数以及心肌应变和做功指标进行分析。36例患者为阵发性AF，30例患者为永久性AF。所有患者CHF病程为17[4；60]个月；AF病程为12[6；36]个月。基线时，左心室射血分数（LV EF）为33[27；37]%。
结果 HCM治疗1年后，LV EF从33[27；37]%显著增加至38[33；44]%（р=0.001）。此外，心肌整体纵向应变（从-6.00[-8；-4]%改善至-8[-10；-6]%；р=0.001）以及心肌做功参数包括整体做功效率（从74[65；79]mmHg%改善至80[73；87]mmHg%；р=0.001）、整体建设性做功（从699[516；940]mmHg%改善至8
